Author(s)
Madeline G. Olson, BA
Taylor Jamil, MD MPH
Keiko Fox, BS
Dexiang Gao, PhD
Mackenzie Daly, MD
Ryan Lanning, MD PhD
Affiliation(s)
University of Colorado Anschutz
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to understand the use of gastrostomy tubes (GT) for management of malnutrition in head and neck cancer (HNC) after treatment with radiation (RT) or chemoradiation (CRT)
Objectives: Evaluate whether patients from lower socioeconomic backgrounds or underrepresented racial groups have higher rates of long-term GT use.
Study Design: Retrospective cohort
Methods: An IRB exempt retrospective review was performed on 784 patients with HNC who underwent definitive RT/CRT for HNC at a tertiary academic center. Patients with thyroid or cutaneous malignancies were excluded. Social disparity variables included age, sex, race and ethnicity, insurance status, number of hospitals in a 25-mile radius from zip code, social vulnerability index (SVI), and distressed community index (DCI) scores. Tumor AJCC 7th stage, RT/CRT type and dosing, initial tracheostomy and GT placement, and a calculated body mass index change (pre-treatment - post-treatment) was also collected. GT placement prior to RT/CRT, during, and post treatment was also collected. The primary endpoint was GT use 1 year post RT/CRT. Comparison and regression analysis was performed to examine what social variables affected long term GT use, while controlling for tumor size, treatment, and RT side effects.
Results: 33% of patients underwent GT placement prior or during RT/CRT with 43 patients (5.5%) remaining GT dependent 1-year post treatment. Concomitant chemotherapy, active smoking, lower initial BMI, increased BMI percentage lost during treatment, recurrent disease, and stage 4 disease were at an increased risk for chronic GT dependency. SVI (p:0.036) and DCI (0.009) scores indicating lower socioeconomic status was associated with higher GT dependency.
Conclusions: Patients from socioeconomically disadvantaged communities have higher chronic GT dependence rates, which increases morbidity of GT-related complications and reduces patients' quality of life. We suggest improved pre and intra treatment weight and swallowing management for these patients at high risk for chronic GT dependence.